Columbus Municipal School District 21st CCLC Parent Inventory

General Questions

The Columbus Municipal School District's 21st Century Community Learning Center Program would like you to respond to a few general questions and also to share your thoughts and ideas about the out-of-school-time activities and services being provided in our community. What do you think of your child’s 21st Century Program in your school district? Your answers will help make the program better for future students and families.

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* 1. Parent/Guardian Name:

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* 2. Please enter the following:

Today's Date:

Date

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* 3. Please enter your name(s) of your students in the program.

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* 4. Please select the grade your child was in the current school year. (Please select only one.)

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* 5. How many years has your child been in the program at this school?

Less than one

3 or more

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* 6. Please identify any activities or services that you participated in at the community learning center.

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* 7. Please select Yes or No to respond to the following questions.

	Yes	No
Did you feel that the services/activities offered were helpful and/or worthwhile for you?	Did you feel that the services/activities offered were helpful and/or worthwhile for you? Yes	Did you feel that the services/activities offered were helpful and/or worthwhile for you? No
Were you comfortable working with the community learning center staff?	Were you comfortable working with the community learning center staff? Yes	Were you comfortable working with the community learning center staff? No
Did the facility have adequate resources and meet your needs?	Did the facility have adequate resources and meet your needs? Yes	Did the facility have adequate resources and meet your needs? No
Did you get the help you were looking for?	Did you get the help you were looking for? Yes	Did you get the help you were looking for? No
Did you feel the services and activities offered for your children were worthwhile?	Did you feel the services and activities offered for your children were worthwhile? Yes	Did you feel the services and activities offered for your children were worthwhile? No
Has the center had a positive impact on any or all of your children?	Has the center had a positive impact on any or all of your children? Yes	Has the center had a positive impact on any or all of your children? No
Did you feel that there was good communication between the regular school staff and the out-of-school-time program?	Did you feel that there was good communication between the regular school staff and the out-of-school-time program? Yes	Did you feel that there was good communication between the regular school staff and the out-of-school-time program? No
Have you talked to your children about the program and about school in general?	Have you talked to your children about the program and about school in general? Yes	Have you talked to your children about the program and about school in general? No

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* 8. How would you rate your child’s out-of-school time program in the following areas?
Select one answer per question.

	Poor	Fair	Good	Excellent	Don’t Know
The overall program	The overall program Poor	The overall program Fair	The overall program Good	The overall program Excellent	The overall program Don’t Know
The safety of your child while he/she is at the program	The safety of your child while he/she is at the program Poor	The safety of your child while he/she is at the program Fair	The safety of your child while he/she is at the program Good	The safety of your child while he/she is at the program Excellent	The safety of your child while he/she is at the program Don’t Know
The atmosphere and comfort of the room(s) in which the program operates	The atmosphere and comfort of the room(s) in which the program operates Poor	The atmosphere and comfort of the room(s) in which the program operates Fair	The atmosphere and comfort of the room(s) in which the program operates Good	The atmosphere and comfort of the room(s) in which the program operates Excellent	The atmosphere and comfort of the room(s) in which the program operates Don’t Know
The snacks that are served to your child on a daily basis	The snacks that are served to your child on a daily basis Poor	The snacks that are served to your child on a daily basis Fair	The snacks that are served to your child on a daily basis Good	The snacks that are served to your child on a daily basis Excellent	The snacks that are served to your child on a daily basis Don’t Know
The hours of operation	The hours of operation Poor	The hours of operation Fair	The hours of operation Good	The hours of operation Excellent	The hours of operation Don’t Know
The transportation provided, if any	The transportation provided, if any Poor	The transportation provided, if any Fair	The transportation provided, if any Good	The transportation provided, if any Excellent	The transportation provided, if any Don’t Know

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* 9. Was transportation provided?

Provided

None

Don't Know

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* 10. To what extent do you agree or disagree with the following statements about the program? (Select one answer per question.)

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t Know
I am satisfied with the kinds of programs and activities offered at the program.	I am satisfied with the kinds of programs and activities offered at the program. Strongly Disagree	I am satisfied with the kinds of programs and activities offered at the program. Disagree	I am satisfied with the kinds of programs and activities offered at the program. Agree	I am satisfied with the kinds of programs and activities offered at the program. Strongly Agree	I am satisfied with the kinds of programs and activities offered at the program. Don’t Know
There is adequate quiet time for my child to complete homework.	There is adequate quiet time for my child to complete homework. Strongly Disagree	There is adequate quiet time for my child to complete homework. Disagree	There is adequate quiet time for my child to complete homework. Agree	There is adequate quiet time for my child to complete homework. Strongly Agree	There is adequate quiet time for my child to complete homework. Don’t Know
The program has helped my child get his/her homework done on time.	The program has helped my child get his/her homework done on time. Strongly Disagree	The program has helped my child get his/her homework done on time. Disagree	The program has helped my child get his/her homework done on time. Agree	The program has helped my child get his/her homework done on time. Strongly Agree	The program has helped my child get his/her homework done on time. Don’t Know
There is adequate opportunity for physical activity.	There is adequate opportunity for physical activity. Strongly Disagree	There is adequate opportunity for physical activity. Disagree	There is adequate opportunity for physical activity. Agree	There is adequate opportunity for physical activity. Strongly Agree	There is adequate opportunity for physical activity. Don’t Know

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* 11. How many days per week of after-school would be ideal for your child?

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* 12. To what extent do you agree or disagree with the following statements describing your child’s experience in the 21st Century Program? (Select one answer per question.)

My child...

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t Know
Enjoys attending the program.	Enjoys attending the program. Strongly Disagree	Enjoys attending the program. Disagree	Enjoys attending the program. Agree	Enjoys attending the program. Strongly Agree	Enjoys attending the program. Don’t Know
Feels comfortable with the staff.	Feels comfortable with the staff. Strongly Disagree	Feels comfortable with the staff. Disagree	Feels comfortable with the staff. Agree	Feels comfortable with the staff. Strongly Agree	Feels comfortable with the staff. Don’t Know
Seems happier or less stressed since participating in the program.	Seems happier or less stressed since participating in the program. Strongly Disagree	Seems happier or less stressed since participating in the program. Disagree	Seems happier or less stressed since participating in the program. Agree	Seems happier or less stressed since participating in the program. Strongly Agree	Seems happier or less stressed since participating in the program. Don’t Know
Has friends in the program.	Has friends in the program. Strongly Disagree	Has friends in the program. Disagree	Has friends in the program. Agree	Has friends in the program. Strongly Agree	Has friends in the program. Don’t Know
Completes homework with greater ease.	Completes homework with greater ease. Strongly Disagree	Completes homework with greater ease. Disagree	Completes homework with greater ease. Agree	Completes homework with greater ease. Strongly Agree	Completes homework with greater ease. Don’t Know
Has a better attitude towards school.	Has a better attitude towards school. Strongly Disagree	Has a better attitude towards school. Disagree	Has a better attitude towards school. Agree	Has a better attitude towards school. Strongly Agree	Has a better attitude towards school. Don’t Know

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* 13. To what extent do you agree or disagree with the following statements about the afterschool staff? (Select one answer per question.)

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t Know
I am comfortable talking with the staff.	I am comfortable talking with the staff. Strongly Disagree	I am comfortable talking with the staff. Disagree	I am comfortable talking with the staff. Agree	I am comfortable talking with the staff. Strongly Agree	I am comfortable talking with the staff. Don’t Know
The staff welcomes suggestions from parents.	The staff welcomes suggestions from parents. Strongly Disagree	The staff welcomes suggestions from parents. Disagree	The staff welcomes suggestions from parents. Agree	The staff welcomes suggestions from parents. Strongly Agree	The staff welcomes suggestions from parents. Don’t Know
The staff keeps me informed about my child’s day at the program.	The staff keeps me informed about my child’s day at the program. Strongly Disagree	The staff keeps me informed about my child’s day at the program. Disagree	The staff keeps me informed about my child’s day at the program. Agree	The staff keeps me informed about my child’s day at the program. Strongly Agree	The staff keeps me informed about my child’s day at the program. Don’t Know
The staff welcomes parents who wish to observe.	The staff welcomes parents who wish to observe. Strongly Disagree	The staff welcomes parents who wish to observe. Disagree	The staff welcomes parents who wish to observe. Agree	The staff welcomes parents who wish to observe. Strongly Agree	The staff welcomes parents who wish to observe. Don’t Know
I am comfortable with how the staff handles discipline problems.	I am comfortable with how the staff handles discipline problems. Strongly Disagree	I am comfortable with how the staff handles discipline problems. Disagree	I am comfortable with how the staff handles discipline problems. Agree	I am comfortable with how the staff handles discipline problems. Strongly Agree	I am comfortable with how the staff handles discipline problems. Don’t Know
The staff encourages positive interactions among the children.	The staff encourages positive interactions among the children. Strongly Disagree	The staff encourages positive interactions among the children. Disagree	The staff encourages positive interactions among the children. Agree	The staff encourages positive interactions among the children. Strongly Agree	The staff encourages positive interactions among the children. Don’t Know
I am satisfied with the number of adult staff available to work with the students.	I am satisfied with the number of adult staff available to work with the students. Strongly Disagree	I am satisfied with the number of adult staff available to work with the students. Disagree	I am satisfied with the number of adult staff available to work with the students. Agree	I am satisfied with the number of adult staff available to work with the students. Strongly Agree	I am satisfied with the number of adult staff available to work with the students. Don’t Know
I am satisfied with the manner adult staff interact with the students.	I am satisfied with the manner adult staff interact with the students. Strongly Disagree	I am satisfied with the manner adult staff interact with the students. Disagree	I am satisfied with the manner adult staff interact with the students. Agree	I am satisfied with the manner adult staff interact with the students. Strongly Agree	I am satisfied with the manner adult staff interact with the students. Don’t Know
The staff has clearly informed me about how to contact them during the afterschool program.	The staff has clearly informed me about how to contact them during the afterschool program. Strongly Disagree	The staff has clearly informed me about how to contact them during the afterschool program. Disagree	The staff has clearly informed me about how to contact them during the afterschool program. Agree	The staff has clearly informed me about how to contact them during the afterschool program. Strongly Agree	The staff has clearly informed me about how to contact them during the afterschool program. Don’t Know
I am satisfied with the overall performance of the staff.	I am satisfied with the overall performance of the staff. Strongly Disagree	I am satisfied with the overall performance of the staff. Disagree	I am satisfied with the overall performance of the staff. Agree	I am satisfied with the overall performance of the staff. Strongly Agree	I am satisfied with the overall performance of the staff. Don’t Know

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* 14. Why does your child attend the program? (Please check all that apply.)

Student needs afterschool supervision

Student is interested because friends are attending

Student is interested because of the enrichment activities offered

Parent is interested in enrichment programs

Teacher recommended program

Student needs homework assistance

Additional reasons for attending program:

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* 15. What would your child be doing after school if he/she were not attending this program? (Please check all that apply.)

Attending a private daycare center

Cared for by neighbors or relatives

Staying at home with adult supervision

Staying home alone

Attending a variety of places over the week

Additional afterschool options

Your comments on the 21st Century Community Learning Centers Program:

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* 16. What do you like best about the program?

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* 17. What are some things you would like to see changed?

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* 18. How many times did you go to the afterschool program?

Once

Two or three times

More than three times

Never

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* 19. Have you been involved as a volunteer in the program?

Yes

If yes, how do you participate?

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* 20. If you would like to make additional comments, suggestions, or ask questions about the program, please use the space below.

Thank you for taking the time to complete the survey and for any comments or suggestions you may have included.

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* 1. Parent/Guardian Name:

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* 2. Please enter the following:

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* 3. Please enter your name(s) of your students in the program.

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* 4. Please select the grade your child was in the current school year. (Please select only one.)

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* 5. How many years has your child been in the program at this school?

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* 6. Please identify any activities or services that you participated in at the community learning center.

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* 7. Please select Yes or No to respond to the following questions.

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* 8. How would you rate your child’s out-of-school time program in the following areas?Select one answer per question.

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* 9. Was transportation provided?

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* 10. To what extent do you agree or disagree with the following statements about the program? (Select one answer per question.)

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* 11. How many days per week of after-school would be ideal for your child?

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* 12. To what extent do you agree or disagree with the following statements describing your child’s experience in the 21st Century Program? (Select one answer per question.)My child...

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* 13. To what extent do you agree or disagree with the following statements about the afterschool staff? (Select one answer per question.)

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* 14. Why does your child attend the program? (Please check all that apply.)

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* 15. What would your child be doing after school if he/she were not attending this program? (Please check all that apply.)

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* 16. What do you like best about the program?

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* 17. What are some things you would like to see changed?

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* 18. How many times did you go to the afterschool program?

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* 19. Have you been involved as a volunteer in the program?

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* 20. If you would like to make additional comments, suggestions, or ask questions about the program, please use the space below.

* 8. How would you rate your child’s out-of-school time program in the following areas?
Select one answer per question.

* 12. To what extent do you agree or disagree with the following statements describing your child’s experience in the 21st Century Program? (Select one answer per question.)

My child...